Provider Demographics
NPI:1285224592
Name:STAVSKY, JARED E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:E
Last Name:STAVSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 W 94TH ST APT BC
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7130
Mailing Address - Country:US
Mailing Address - Phone:614-378-0937
Mailing Address - Fax:
Practice Address - Street 1:265 MADISON AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0971
Practice Address - Country:US
Practice Address - Phone:212-768-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTBD390200000X, 1223G0001X
NY0626091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program